Hello,
Here is a short list of the multiple responses that I have received. The answer is yes you can bill for the work that has been completed minus the salvage value of what was made. In this case I can bill for everything except the fitting and follow up time that would have been necessary, so I will figure that out.
There were quite a few who had similar cases to mine and felt like they could not bill for what they had done or were unsure, so didn’t. I believe that if you were in this category and have not billed for it, you could go back and bill for it now if you are within the medicare timeline for billing. It is quite a while, well over a year I believe.
Thank you to all who responded.
Nathan Keepers, CPO
Original ? followed by responses:
Hello,
I may be wrong, but I thought that we could bill medicare for work
completed that is not delivered in some instances. Is that only in
death of the patient, or can it apply in other instances?
I have a patient that was cast for a custom knee brace and then
decided that they didn’t want it when it arrived. They did not refuse it after
they saw it, they won’t even come in for the fitting appointment. It’s
custom and can’t be used on someone else.
Any advice on where to look at the rules, or how to proceed would be
appreciated. Also, how do you avoid similar situations. Require a
deposit?
Thank you,
Nathan Keepers, CPO
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The link below will provide you with the answer to your question posted
on the list serve relating to billing Medicare for a custom orthosis
when the patient refuses it. If you have a problem with the link, the
information can be found in the Medicare Carriers Manual 2005.3 The
section is entitled Artificial Limbs, Braces, and other custom made
items ordered but not furnished.
http://www.cms.hhs.gov/manuals/14_car/3b2000.asp#_1_5
It is my understanding that you can bill and get paid minus the salvage
value (which in this case is zero.
———–
I had a womwn a couple years ago that I made an AK for and she tried
that
little stunt (she refused the leg on the date of delivery). I billed
the leg
minus the retunable parts (ie foot and knee) and got paid. It was a S/A
foot
and safety knee. I got paid for a socket and test socket etc. Still
worked
out as there was 0 follow up.
You can bill medicare for the orthosis if it was custom made and you have a written Rx for the device
Proof of Delivery is addressed in the Fraud and Abuse section of the
Medicare Manual. I recall something about being able to use UPS and
the
tracking information as proof when a patient cannot be contacted for
delivery, but I don’t see it in there now.
I usually conatct the physician that ordered the brace and let them know about this problem.If the physician can’t talk some sense into them,then I would make sure that everyone signed a waiver of liability before proceding with services for future elimination of the problems.I would contact an attorney to make sure that this waiver is legal in your area first. I would basically offer to come to their house and if that was turned down then make sure the problem isn’t money.If they don’t want to pay their copay then a hardship case can be established and you can write off your part.At least it is some money rather than being stuck with bill. I don’t depend on the hardship situation by any means but it can be a useful tool. Sometimes your suppleirs of the custom device can be pursuaded to help with the costs if the brace can be returned for a credit. Just remember,don’t discount the item for any reason.This will get you in the long run.I hope you find you solution.It really bi!
tes when
things like this force us to pulling our hair because they won’t do their end. Good luck. I wish i could help more.
Nathan, Yes, you can bill for the service if the patient consents to
treatment at the time of evaluation and measurement and then refuses
delivery. I had a similar circumstance when I went to a client’s home
and measured for an afo attached to shoes. He wasn’t diabetic and I
explained that there would be a charge for the other shoe as well as the
20% co-pay. I had a consent to treatment, but they balked at accepting
responsibility for the co-pay. This man was blind and was living with
his sisters. I directed most of my questions to the client which
offended the sisters. After I went to do an initial fit on the shoes, they
began to find other things to object to, such as I wanted to come when
it was inconvenient for them, or I was rude. Basically, they didn’t
want to pay any part of the co-pay. In those cases, I usually try to
establish if there is some condition of financial hardship and then go
ahead and deliver as a favor to my referring sources. Before I could do
that, they screwed me and found someone else to provide the orthosis —
didn’t even have the courtesy to tell me until after this had happened!
I went ahead and billed Medicare for this service as a salvage claim
and wrote a letter detailing the circumstances and itemizing the charges
and I got paid something for my trouble. Long story — lots of hassle,
but at least I got something out of it.
————–
Check your state’s consumer laws. Some states hold that an order for a
custom device, appliance, automobile, windows, doors, construction,
etc.
must be cancelled with in three business days by the person placing the
order or they must pay for the item whether or not they take delivery.
You can file it as a salvage claim just as if the patient died. Go to
PalmettoGBA.com-providers/DMERC/FAQS (team tips,Autumn 2002).
(this is taken from the address immediately above this)
A salvage claim can be filed for the labor and non-salvageable parts of a custom item for the following reasons:
Beneficiary dies before artificial limb, brace, or other custom-made item is furnished;
Beneficiary cancels order before artificial limb, brace, or other custom-made item is furnished; or
Artificial limb, brace, or other custom-made item order is no longer medically necessary or condition changes before item is furnished.
I have had similar circumstances in the past and yes you can bill for the work that was done. Basically, you need to take the base code for the orthosis and subtract what wasn’t done i.e. fitting, follow-ups, etc. This will give you the amount you can rightfully bill Medicare. You cannot accept any money upfront from the patient unless you are billing Medicare unassigned. Also, in some circumstances if you can reuse parts from the orthosis you would need to subtract that as well from the base code. If you need further clarification I suggest you contact Medicare directly. Hope this helps
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